4.9.1.2 Levodopa

ChoiceDrugDosage
1st choiceCo-beneldopa (Madopar®) containing levodopa and benserazideDose:
See BNF - seek specialist advice
Or
Co-careldopa (Sinemet®) containing levodopa and carbidopaDose:
See BNF - seek specialist advice

Prescribing Notes

  • To reduce the risk of nausea, start with a low dose and build up slowly. Levodopa should not be withdrawn abruptly. It may colour urine red
  • Levodopa is a useful first line drug for older/frailer patients to optimise control faster
  • Levodopa containing preparations are normally prescribed as their individual components, however, be aware that the total dose is sometimes referred to e.g. Madopar 50mg/12.5mg as Madopar 62.5mg
  • Co-beneldopa (Madopar®) and co-careldopa (Sinemet®) are used equally and there is no evidence of benefit of one over the other
  • Dispersible Madopar® may be useful where rapid absorption is desired, for example first thing in the morning. Patients should be advised to dissolve in plenty of water; often an inactive sediment remains in the glass
  • Modified-release formulations of levodopa are not recommended for initiation of therapy. They may be useful for nocturnal immobility and rigidity e.g. some patients are prescribed a modified release preparation at night and immediate release preparations during the day